Overview
In This Section |
This section contains the following topics:
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1. Intake Process for FDCs
Introduction |
This topic contains information about the intake process for the receipt of FDCs, including
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Change Date |
August 6, 2015
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III.i.3.B.1.a. Initial Actions to Take Upon Receipt of an FDC with an eFolder |
Take the following actions within one day of receipt of a fully developed claim (FDC) when there is an electronic claims folder (eFolder)
References: For more information about
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III.i.3.B.1.b. Initial Actions to Take Upon Receipt of an FDC for Claims With Paper Claims Folder |
Take the following actions within one day of receipt of an FDC that has a paper claims folder
Note: A paper claims folder is a claims folder that has not yet been scanned into the electronic claims processing system.
References: For more information about
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2. Excluding Claims From the FDC Program
Introduction |
This topic contains information about excluding claims from the FDC Program, including
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Change Date
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February 19, 2019 |
III.i.3.B.2.a. Excluding a Claim From the FDC Program at CEST |
Even though a claimant submits one of the EZ forms listed in M21-1, Part III, Subpart i, 3.A.2.a, the claim must be reviewed at the claims establishment stage to ensure it qualifies for FDC processing.
Use the table below when establishing a claim submitted on an EZ form to determine if it must be excluded from the FDC Program.
Notes:
References: For more information on the
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III.i.3.B.2.b. Reasons for Subsequent Exclusion of a Claim From the FDC Program |
If at any time during the processing of an FDC, a reason for exclusion is met, the claim must be excluded from the FDC Program.
See the table below for a description of the reasons for subsequent exclusion of a claim from the FDC Program.
Important: When guidance on excluding an FDC has changed during the processing of the FDC, follow the instructions in M21-1, Part III, Subpart i, 3.B.2.g.
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III.i.3.B.2.c.Submission of Additional Evidence and FDC Exclusion |
In some cases, the submission of additional evidence does not require an automatic exclusion from the FDC Program. Do not exclude a claim from the FDC Program if the claimant or his/her POA submits
Reference: For more information on the determination to exclude from the FDC Program after sending a development letter, see M21-1, Part III, Subpart i, 3.B.3.h.
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III.i.3.B.2.d. Process for Excluding a Claim From the FDC Program |
If it becomes necessary to exclude a claim from the FDC Program, regional offices (ROs) must follow the steps in the table below.
Exception: The steps in the table below do not apply when excluding a BDD claim. These claims do not require claimant notification or an FDC exclusion special issue indicator.
Note: After excluding a claim from the FDC Program, provide the claimant with the notice 38 U.S.C. 5103 required only if VA excluded the claim because the claimant
Important: An unsigned application for benefits received on or after March 24, 2015, must be handled as an incomplete application as instructed in M21-1, Part I, 1.B.1.g.
References: For more information on
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III.i.3.B.2.e. Special Issue Indicators and Required Notification for FDC Exclusion |
If it is necessary to exclude a claim from the FDC Program,
Use the table below to select the appropriate special issue and notification text.
References: For more information on
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III.i.3.B.2.g. Applicability of FDC Guidance Changes |
Use the table below to determine the appropriate action when changes in guidance occur during the processing of an FDC.
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3. Development VA Undertakes in Connection with FDCs
Introduction |
This topic contains information about development VA undertakes in connection with FDCs, including
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Change Date |
February 19, 2019
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III.i.3.B.3.a. Limitations on the Development of FDCs |
The only development VA undertakes in connection with an FDC is to request
Notes: When submitting a request for records from a Federal records custodian in connection with an FDC
Reference: For more information on requesting records from an MTF, see M21-1, Part III, Subpart iii, 2.B.4.
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III.i.3.B.3.b. Handling the Final Notification Letter for Federal Records |
If it becomes apparent that records VA requested from a Federal records custodian in connection with an FDC are unavailable, follow the instructions in M21-1, Part III, Subpart iii, 1.C.1.e.
In addition to the notice elements described in M21-1, Part I, 1.C.5.b, include the following in the final notification letter:
We received your claim and your request to participate in the Fully Developed Claim (FDC) Program. Though you indicated you have no other information or evidence to give VA to support your claim, we are required to send you this notice. If you have information or evidence not previously submitted to VA that supports your claim, we recommend you submit it. As a reminder, if you identify or submit any additional information or evidence at this point, VA will remove your claim from the FDC Program and process it under standard claims-processing procedures.
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III.i.3.B.3.d. FDCs and Special Issue Development |
If an FDC includes one of the special issues that require a subsequent development letter as noted in M21-1, Part I, 1.B.1.f, FDC exclusion is notappropriate at claims establishment as there was no prior notice to the claimant to provide the additional information/evidence necessary to develop and adjudicate the claim.
Exception: Claims falling under one of the “Special Circumstances” noted on Page 2 of VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits, such as PTSD or individual unemployability, must be excluded from the FDC Program if filed without the necessary additional form(s) and adequate supporting evidence is not already of record. Important: Do not send the development letter if the evidence of record
Example: If a Veteran claiming service connection (SC) for hepatitis C submits medical records that address risk factors for the disease, do not send a letter soliciting hepatitis risk factors, as this information is addressed by the evidence of record.
References: For more information on
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III.i.3.B.3.e. MST Protocol and FDCs |
MST claims require special handling and contact with the claimant. Development to a claimant that aligns with MST protocol will not be an exclusion from the FDC Program. Do not exclude MST claims from the FDC Program based on
Reference: For more information on notification requirements for special issue claims, see M21-1, Part I, 1.B.1.f. |
III.i.3.B.3.f. FDCs and Vet Center Records |
FDC exclusion is not appropriate at claims establishment when a Veteran identifies Vet Center records that require completion of a VA Form 21-4142 and/or VA Form 21-4142a, as there is no prior notice to the claimant that these Federal records require a release form.
RO personnel should request that the claimant provide the VA Form 21-4142 andVA Form 21-4142a for the Vet Center records, when required, and include the language shown in M21-1, Part III, Subpart i, 3.B.3.g.
Important: If the claimant responds with only the requested form or the related records, the claim will remain in the FDC Program.
Reference: For more information on the determination to exclude from the FDC Program after sending a development letter, see M21-1, Part III, Subpart i, 3.B.3.h.
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III.i.3.B.3.g. Additional Language for FDC Development Letters |
Some FDCs require additional requests for information from the claimant because the upfront notification on the claims form does not adequately inform the claimant of the evidence required to substantiate the claim. These include
In these cases, when an FDC requires a development letter, ROs must enter the following text under the FREE TEXT menu, Important Information section:
You submitted your claim under the Fully Developed Claim (FDC) Program; however, we need additional information from you. Since your claim is part of the FDC Program, if you submit evidence other than what is requested below, your claim will be excluded from the FDC Program.
References: For more information on
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III.i.3.B.3.h. Determination to Exclude from the FDC Program After Sending a Development Letter |
Use the table below to determine whether a claim should be excluded from FDC processing after sending the required development letter to the claimant.
References: For more information on
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III.i.3.B.3.i. Telephone Development and FDC Exclusion |
A telephone call to a claimant to clarify information will not require exclusion from the FDC Program if the telephone call can be completed at the time the action is being taken on the claim. Exclusion would be appropriate when contact with the claimant is unsuccessful and the need for clarification would require the initiation of additional development.
Example: A claimant submits medical evidence from a physician and attaches aVA Form 21-4142 or VA Form 21-4142a. The Veterans Service Representative (VSR) calls the claimant to clarify if the claimant wanted VA to develop for additional records. Provided the VSR reaches the claimant the same day and the claimant provided a negative response, the claim will not be excluded from the FDC Program.
Important: Exclusion would be appropriate if
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4. Determining the Appropriate Effective Date for a Grant of Benefits Under the FDC Program
Introduction |
This topic contains instructions for determining the appropriate effective date for a grant of benefits under the FDC Program, including
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Change Date |
February 19, 2019 |
III.i.3.B.4.a. Determining the Appropriate Effective Date for a Grant of Benefits Under the FDC Program |
VA law allows for several circumstances whereby a Veteran may be assigned an effective date for payment that is earlier than the date VA received the claim. There are several bases decision makers must consider for retroactive effective dates, such as
When granting claims under the FDC program, consider each rule for assigning an effective date separately, and assign the most advantageous effective date that applies to the facts of the case.
Important: Only one effective date law can be used for each service-connected disability granted.
See the table below for considerations when assigning a retroactive effective date to an FDC.
Note: Under PL 112-154, Section 506, an original claim is the initial formal (complete) claim filed by a Veteran for disability compensation. Consequently, a Veteran who has applied for non-service-connected pension in the past is potentially eligible for a retroactive date under PL 112-154, Section 506 upon filing an original FDC for disability compensation.
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III.i.3.B.4.b. Instructions for Applying the Provisions of Section 506 of PL 112-154 |
When application of the provisions of Section 506 of PL 112-154 is in order, the proper effective date for a grant of benefits is whichever of the following dates is most advantageous to the claimant based upon the facts of the case:
Notes:
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III.i.3.B.4.c. Explaining FDC Effective Dates |
See the table below for additional explanation required in the rating decision when assigning effective dates in FDC claims.
Reference: For more information on the rating decision narrative, see M21-1, Part III, Subpart iv, 6.C.
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<iii.i.3.b.4.dIII.i.3.B.4.d. Example 1: Proper Application of the Provisions of Section 506 of PL 112-154</iii.i.3.b.4.d |
Scenario:
Result: On December 12, 2013, VA granted the Veteran’s claim and assigned a 30-percent disability evaluation to the knee, effective September 1, 2012.
Rationale:
Reference: For more information on identifying an incomplete FDC, see M21-1, Part III, Subpart i, 3.A.2.j.
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III.i.3.B.4.e. Example 2: Proper Application of the Provisions of Section 506 of PL 112-154 |
Scenario:
Result: VA granted SC for asthma effective September 15, 2015, which represents the earliest date medical evidence confirmed a diagnosis of asthma.
Rationale: The assignment of an effective date of April 15, 2014, one year retroactive to the date of receipt of the ITF, is improper for two reasons:
Important: If the medical or other evidence submitted with the FDC did not clearlyshow this was the Veteran’s first complaint and/or diagnosis, then the Veteran should be afforded the benefit of the doubt and awarded the full one year retroactive effective date from the date of receipt of the ITF.
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5. Revisions of FDC Decisions
Introduction |
This topic contains instructions for processing revisions of decisions made under the FDC Program, including |
Change Date |
February 19, 2019
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III.i.3.B.5.a. Handling Disputes With Exclusion from the FDC Program |
A legacy NOD or request for decision review filed by a claimant in response to a notice that the claim was excluded from the FDC Program is not considered valid. Send notice to the claimant that the submission is not considered valid as no final decision had been made at the time he/she expressed disagreement.
If the claimant timely disagrees with or requests decision review regarding exclusion from the FDC Program after notice of the rating decision on the excluded claim,
References: For more information on
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III.i.3.B.5.b. Granting the FDC Retroactive Effective Date During the Legacy Appeal Period |
A legacy appellant may qualify for a retroactive effective date under PL 112-154, Section 506, even if the legacy NOD is received on or after August 6, 2015. The issue as to whether the FDC retroactive effective date applies is whether the Veteran successfully made it to the initial rating decision as a member of the FDC Program. Once the initial rating decision is issued, there is no further need to determine whether to exclude the Veteran from the program.
If the Veteran meets all other requirements for the retroactive effective date underPL 112-154, Section 506, the FDC effective date should be awarded to any original grant of SC based on a
Note: A separate claim can co-exist with the legacy appeal without disqualifying the appeal from being considered under the FDC Program’s guidelines.
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6. FDC Folder Flash
Change Date |
August 6, 2015 |
III.i.3.B.6.a. FDC Folder Flash |
The image below represents the folder flash ROs must attach to a paper claims folder associated with an FDC.
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Historical_M21-1MRIII_i_3_SecB_12-19-2014.docx | May 8, 2019 | 104 KB |
Change-December-19-2014-Transmittal-Sheet-M21-1MRIII_i_3_SecB_TS.docx | May 8, 2019 | 38 KB |
Historical_M21-1III_i_3_SecB_8-6-15.doc | May 8, 2019 | 238 KB |
Historical_M21-1III_i_3_SecB_9-12-17.docx | May 8, 2019 | 120 KB |
Historical_M21-1III_i_3_SecB_2-17-16.doc | May 8, 2019 | 262 KB |
11-18-15_Key-Changes_M21-1III_i_3_SecB.docx | May 8, 2019 | 112 KB |
9-12-17_Key-Changes_M21-1III_i_3_SecB.docx | May 8, 2019 | 113 KB |
3-7-17_Key-Changes_M21-1III_i_3_SecB.docx | May 8, 2019 | 116 KB |
2-19-19_Key-Changes_M21-1III_i_3_SecB.docx | May 8, 2019 | 96 KB |
2-1-16_Key-Changes_M21-1III_i_3_SecB.docx | May 8, 2019 | 108 KB |
1-21-16_Key-Changes_M21-1III_i_3_SecB.docx | May 8, 2019 | 137 KB |
M21-1MRIII_i_3_TS.doc | May 8, 2019 | 55 KB |
Change-August-6-2015-Transmittal-Sheet-M21-1III_i_3_SecB_TS.docx | May 8, 2019 | 46 KB |
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